Cesarean Section

Cesarean Section

A Cesarean Section (also known under the name of C-Section) is a surgical intervention involving a laparoscopic incision through the abdomen of the mother and another incision through her uterus (hysterotomy) in order to deliver the baby – it is also possible to deliver multiple babies through this procedure. Typically, this procedure is employed when vaginal birth is not possible or when it would cause a high risk to the mother’s or the baby’s life or health state. However, studies have shown that recently there has been an increase in the number of patients requesting a Cesarean Section delivery, even though the births may have been natural. Despite the WHO (World Health Organization) recommendations that the Cesarean Section birth rates should be kept under 15%, in some countries the rate has been exceeded – for example, in 2006, in the US over 31% of the births have been assisted through this procedure.

In many cases, the natural birth method is not recommended, such as in situations when the patient or baby are affected by certain medical conditions. Such situations may include, but are not limited to failure to progress (dystocia) or prolonged labor, cord prolapse, fetal distress, uterine rupture, placental disorders (for example placenta accreta, placenta praevia or placental abruption), breech or transverse positions or other abnormal presentations, failure in induction of labor, failed delivery by forceps or ventouse, macrosomia (exceedingly large baby), abnormalities concerning the umbilical cord (for example velamentous insertion, multi-lobate placentas, vasa previa) or contracted pelvis. Other examples of disorders and conditions that may require a Cesarean Section are hypertension, pre-eclampsia, multiple births, HIV infection, high risk fetus, previous applications of this procedure, certain sexually transmitted infectious diseases, perineum healing problems or a history of such disorders. Also, this procedure may be employed in cases that would permit vaginal delivery, however the obstetrician is not able to perform it (lack of skill concerning multiple births, breech births and other complications) or the technology employed causes problems (for example, on account of improper use of EFM technology – electronic fetal monitoring).

Cesarean Section Description

In medical practice, there are a number of procedures that may be applied to perform a Cesarean Section. The main difference between them consists of the incision performed on the uterus and the type of laparoscopic operation performed to access the uterus. The traditional operation involves performing a longitudinal incision along the midline, allowing a large space through which to deliver the baby. This type of operation is no longer used on a large scale as it often causes complications. Instead, health care professionals around the world have adopted more recent surgical techniques which provide greater safety for both the mother and the baby or babies, as well as faster recovery with minimal complications.

A more common procedure today is the lower uterine segment section, which is performed as a transverse incision above the bladder, resulting in reduced blood loss. This is the most widespread procedure at this time, and while it is not the only one being employed it offers the greatest benefit with minimal risks. Emergency C-sections are operations performed after the labor has started. This operation does not imply a special procedure; however it is classified as a different type due to the particularities involved. Crash Cesarean Sections are operations performed in emergency situations, when complications appear suddenly during labor and immediate action is required in order to ensure that both the mother and the baby or babies are safe.

Cesarean hysterectomies are operations which end with the removal of the mother’s uterus. These are typically performed in cases where intractable bleeding occurs or when the uterus and the placenta have grown together and can not be separated. Repeat Cesarean Sections are operations performed on a patient that has previously undergone Cesarean operations, and are usually performed through the scar remaining from the previous operation. Other types of sections have been used in the past, but are no longer frequently employed. Examples of such procedures include extraperitoneal Cesarean or Porro Cesarean.

Cesarean Section Related Medication

During Cesarean section operations, both anesthetic medication and antibiotics are used. Anesthetics are employed in order to block the pain from the surgery while antibiotics are used as prophylactic agents in order to prevent any infections from occurring at the site of the surgical operation. In general, both regional and general anesthesia may be employed. Spinal anesthesia, epidural and combined epidural and spinal anesthesia have been performed, however regional anesthesia is preferable, allowing the mother to interact with the baby immediately after delivery. Also, regional anesthetics also have a lower risk factor than general anesthetic agents for most complications (such as pulmonary aspiration of gastric contents which has a medium to high incidence rate, especially for patients who undergo anesthesia during late pregnancy).

General anesthesia, while only employed in around 5% of the cases, is necessary in situations where the mother and child may be exposed to certain risks. For example, in the case of patients with heavy or uncontrolled bleeding, the hemodynamic effects induced by regional anesthesia may further aggravate their condition. Also, in emergency situations when the available time does not allow the health care specialists to successfully perform regional anesthesia (such as in case of severe fetal distress), general anesthesia is the only available alternative.

Antibiotic prophylaxis should be performed in all cases of Cesarean Section operations. Antibiotics are administered as prophylactic agents in order to prevent infections from occurring during or after the operation has been completed. Numerous antibiotic regimens are available for this purpose, and the physician’s decision on this matter depend largely on a number of factors including the mother’s age, health state and medical history, as well as drug availability and personal preference. Typically, the antibiotic is administered as a single dose prior to the Cesarean Section operation, but in some situations the patient may require continuous administration of the medicines or repeat doses at regular intervals during and after the operation. In all cases, the mother and baby will be kept under medical attention after the surgical procedure has been finalized in order to detect any abnormal signs and symptoms which may appear.